Large Multicenter Trials: Behavior Determinants or Doubt Generators?

pp 383-393

Abstract

Sudden death has been a subject of special interest in medicine for years and particularly in the last decades. This is due to the fact that 20% of the natural deaths and 50% of cardiac deaths are sud-den, although only 40% of the later has a previous cardiopathy diagnosis. It is in most cases the first sign of the sickness. Sudden death is not only caused by arrhythmias. Ischaemia, autonomic disbalance and low left ejection fraction are also important factors. Having in mind that 75-80% of that kind of deaths are due to ventricular tachycardia or ventricular fibrillation, the importance of its treatment and prevention is quite evident. However, this treatment not always gives the expected results and occasionaly can worsen its natural evolution. It is necessary define a rational treatment criteria. Nowadays there is a general consensus that once the reversible causes have been discarted, the treatment is amiodarone versus implantable cardioverter defibrillator. It is convenient to analize what has been published because at least it is not that clear. Regarding this there are large multi-center trials which seem to be the proper way and tend to solve this problem. The purpose of this paper is to deeply analize those multicenter trials to emphasize its conclusions.